Feb 27 (Reuters Health) - Physicians are failing to prevent
blood clot formation in nursing home and hospital patients,
leading to 60,000 to 100,000 preventable deaths each year,
public health officials said Wednesday.
The deaths are mostly due to pulmonary embolism (PE), when a
blood clot breaks off from the leg vein and lodges in the lung,
cutting off the oxygen supply. As many as two million
people--mostly those in hospitals, nursing homes or sick and
immobile at home--develop leg clots, called deep- vein
thrombosis (DVT), each year.
Two-thirds of DVT patients end up with chronic leg swelling,
and as many as 600,000 develop the often-fatal lung clots, said
Dr. Samuel Goldhaber, a professor at Harvard Medical School and
an expert on the conditions.
"Despite these startling statistics, DVT is not
capturing the level of public attention that it deserves,"
said Georges Benjamin, executive director of the American Public
Health Association (APHA). "It continues to be an
under-estimated, under-diagnosed and under-treated public health
threat."
Despite recent reports about DVTs from long plane rides,
there has not been any spike in DVT and PE. But public health
specialists and many physician groups have become increasingly
alarmed that despite ample evidence on what causes the clots and
how to prevent them with blood thinners, there has been very
little concerted action to stop them.
The APHA and the Centers for Disease Control and Prevention (CDC)
are calling for a huge campaign to boost physician interest and
to make Americans as acutely aware of their DVT and PE risk
factors as they are for heart attacks and stroke.
In a survey released Wednesday, 74% of the 1,003 men and
women queried had not heard of DVT or PE, and 57% could not cite
any common risk factors.
Having surgery--and being inactive afterwards- -is the single
biggest risk for developing a clot. Doctors and nurses are doing
a much better job of preventing clots in surgical patients, said
Goldhaber.
But many people with other risk factors are put into a
hospital, nursing home or rehabilitation facility, and are not
getting proper preventive treatment, he said. In a study of more
than 5,000 patients with confirmed DVT, 71% had not received low
molecular weight heparin, a blood-thinning medication that stops
clot formation.
Risk factors include being overweight or a smoker; taking
birth control pills or hormone replacement therapy; having
cancer, paralysis, high blood pressure, heart failure or
respiratory failure; and having a family history of DVT or PE.
Some people also have inherited clotting disorders that put them
at risk.
"Almost every patient admitted to a hospital today has
risk factors," said Victor Tapson, a professor of pulmonary
and critical care medicine at Duke University Medical Center.
Tapson said there are already good guidelines on clot
prevention but that physicians don't follow them partly because
they underestimate DVT and PE risk, or worry that the patients
might have too much bleeding from the heparin.
People who are hospitalized, in nursing homes or laid up sick
at home should tell their physicians about all their potential
risk factors, and ask if they need to be on heparin, said
Goldhaber.